Health Sector Activities and Problems

Main Activities Of The Municipal Health Directorate

•  Planning and Budget for Health Services and programmes
• Conducting in-service Training for level "B" staff.
• Supervision and monitoring of Health activities and projects in the District.
• Procurements of Logistics.
• Recruitment of staff through Regional Health Directorate.
•  Embarking on Health projects and Health Educational campaign.
• Providing supportive services (eg. Finance and Transport).
• Human and Material Resource Management.

Institutional Care

All the Health Institution provides curative services as well as preventive services.

PLAN AND PROGRAMMES

The Health management team headed by the Municipal Director of Health Services. (MDHS) prepares plans and programmes which is mostly done annually.

COMMUNITIES INVOLVEMENT IN PLANNING AND IMPLEMENTATION OF PROGRAMMES.

Beneficiary communities are involve in the planning and programmes through community Entry, consensus building on decision making and by community mobilization

ACTIVITIES /PROGRAMMES UNDER TAKEN BY THE GHS FOR THE YEAR UNDER REVIEW.

• HI V/AIDS Educational campaign

• Expanded programme on immunization

• Reproductive and child Health /Family planning services.

• Onchcerciasis control by community directed treatment with /Vermectin

• Food Aid Supplementation to malnourished children.

• Tuberculosis/Leprosy control.                                    

• Implementation of community Based Health planning and Services ’(CHPS).
  

SOURCE OF FUDIND

1. Government of Ghana (GOG)
2. Donor pool fund (DPF)
3.  Assembly.
   

BUDGET PREPARATION

Budgets are prepared by the Municipal Health Management Team (DHMT), which is headed by  Director of Health Services (DDHS)

APPROVAL OF BUDGETS

Budgets are normally forwarded to the Minister of Health through the Regional Director of Health Services for submission to parliament for approval.

THE DEPARTMENT RELATIONSHIP WITH THE ASSEMBLY

The Department collaborates with the Assembly to formulate strategies to implement Health programmes. The Department also provides technical support in the execution of Health projects, like siting of clinics.

ASSEMBLY SUPPORT

Ghana Health Services periodically receives financial and transport support from the Assembly. The Assembly also supports Health projects like building of staff quarters and clinics, to the extent that most of the rural clinics were built by E.U. through the Assembly.

GHS COLLABORATION WITH OTHER DEPARTMENTS

Ghana health Service liaise with other Department and Agencies to undertake integrated services towards disease control and Eradication.

AVAILABILITY OF EQUIPMENTS

Health Centres and Rural Clinics normally do not have enough of the following basic equipments to operate effectively due to frequent breakages and malfunction.

•  Blood pressure apparatus
• Dressing Sets                     
• Sphygmomanometer 
• Stethoscope.
• Delivery Set.
  

PATRONAGE OF HEALTH FACILITIES

People in the Municipality do patronize the service of the health facilities because of:-

• Quality care provided in the facilities
• Right caliber of staff
  
  

Eighteen (13) functional community clinics are also in practice in some selected.

CONSTRAINTS

• Inadequate of Skilled Staff

•  Lack of accommodation (urgently needed is Bonsu Rural Clinic for a resident midwife).

•  Portable water for the level ’B’ clinics (i.e. the Health Centres and the Rural Clinics.

• Inadequate funding for Health activities.

• Lack of transport for  Health Directorate.

• Staff quarters at Yefri and Nkoranza Health Centre need rehabilitation.

• Lack of facilities at the  hospital.1 for offering maternal and child health services and obstetric services.

COMMENTS

The staffing situation in the Assembly is woefully inadequate for the smooth running of the Health institutions. The  Assembly therefore has to put in place sponsorship package for training of Nurses to help solve the problem.

HEALTH AND SANITATION

The good health of the population is a prerequisite for development. Since individuals contributions to development activities are enhanced by good health.

The base line survey revealed that the district is confronted with several health problems as entailed below.In adequate health facilities:  the exicting health facilities ranging from village health post to District Hospital.

HEALTH AND NUTRITION

With regard to nutrition, the data available during the base line survey indicates that the amount and quality of food eaten in the district are inadequate inappropriate and non-nutritious. Most of the children were malnourished.

Guinea Worm Infestation

Guinea worm infestation is virtually eliminated from the district.  According to statistics from the  Health Directorate, there was only 1 reported case in 2007 as against 8 in 2005 and 5 in 2006. The year 2009 recorded no cases of the infestation. This success story is as a result of increased supply of potable water to the communities and mass education on the disease district-wide.

National Health Insurance Scheme

The National Health Insurance Scheme was pioneered by the Nkoranza . The Scheme in 2008 registered 79,488 representing 50.2% of the entire Population of the then Nkoranza . In 2009 the scheme recorded a registered membership of 70,917 representing 76% of the district population. Some of challenges of the scheme include:

• Inability of the scheme to pay user facilities on time due to high turn out of client at the head facilities
• Non enrolment of majority of the population
• Late renewal of client membership
• High cost of Hospital bills and drugs.
  

Health Infrastructure

Nkoranza South  has a total of nine (9) health facilities comprising one (1) hospital, seven (7) health centers and one (1) CHPS compound Amponsakrom Rural Clinic is under construction. On completion it will add up to the stock institutions to be ten (10). Below is the list of health facilities available and ownership .

Health Sector Activities

All the health institutions in the  provide curative as well as preventive services.  The  Health Management Team (DHMT) headed by the  Director of Health Services (DDHS) prepares plans and programmes in that direction for implementation annually.  Beneficiary communities are involved in the planning and programmes through community entry, consensus building on decision-making and community mobilization.  The Health Directorate by its establishment performs the following functions among others.

1. Planning and budgeting for health services and programs
2. Conducting in-service training for all health staff in the district 
3. Supervision and monitoring of health activities and projects in the district 
4. Procurement of logistics 
5. Recruitment of staff through the Regional Health Directorate 
6. Disease control and surveillance 
7. Embarking in Health projects and Health Education campaign 
8. Providing support services (e.g. Finance and Transport) 
9. Human and Material Resource Management

The Directorate derives its funds from

• Central Government (Ministry of Health (GOG)
• Donor Pool Fund (DPF) and 
• Municipal Assembly (MA)
  

Top Ten Causes of Morbidity /Hospital Attendance

There is correlation between a population’s health status and its productivity. The labour force is most often threatened by diseases.  The commonest cause of morbidity in the disease is Malaria, representing about 47% of OPD attendance.  The dangers of malaria cannot be overemphasized.  This is because malaria causes death in children and pregnant women.  About 13.2% of deaths nationwide are caused by malaria.  Table…..below shows the hierarchy of the district’s most common diseases.

From the table above, the top ten (10) diseases  range from malaria through diarrhea to pregnancy related malaria.  Malaria takes the highest percentage of (47%) with malaria in pregnancy taking the least (1.0%).  Apart from malaria, some of the important diseases in the district are environmental sanitation related.  These include Acute Reparatory Infections (ARI), skin diseases, Intestinal worms and diarrhea. 

The implication of the analysis is that, the people are faced with sanitation problems such as stagnation of water during heavy downpours, polluted water bodies and un- kept refuse disposal with their resultant effect of aerating an enabling environment for mosquitoes to breed which has resulted in the high incidence of malaria in the district.

Malaria accounted for 48.2%, 47.1%, 45.7% and 44.6% in 2005, 2006, 2007 and 2008 respectively.  The statistics suggest that the district has not made significant progress in the last five years to health and / or reduce the incidence of malaria.  This raises concerns about environmental sanitation and the effectiveness of methods adopted in preventing malaria infection. 

Top Ten causes of Death/Mortality

The Hospital recorded a total of 188, 176 and 184 deaths in 2007, 2008 and 2009 respectively. The Top Ten Killer Diseases are listed in Table 1.48 It is seen that Malaria, Anaemia, HIV/AIDS and Pneumonia were the top ten killer diseases between 2007 and 2009. Malaria continues to pose health threat .

Communicable Diseases in the  identified in 2008 & 2009

The highest cases of communicable diseases identified in the health institutions in 2008 and 2009 are recorded in Table 1.49 They include HIV/AIDS, Tuberculosis and Meningitis. HIV/AIDS is fast becoming a serious health threat in the. Efforts at stemming the spread of the disease are to be stepped up.

It appears malaria cases appear to go down compared to the 2008 figure.  The fact remains that malaria is still high .  In view of the magnitude of the malaria problem, the Assembly has been selected to participate in the voices for Malaria – Free Future pilot projects in Ghana.  The programme aims to mobilize Leadership in Government and Civil Society to be involved in malaria programmes, enhance -level advocacy, improve policy dissemination and reduce barriers to policy implantation, and advocate for increased funding for malaria . 

The project has been launched in the Municipality and a  Malaria Advocacy Team (DMAT) has been inaugurated to spearhead the malaria free campaign.  It is expected the project, when well supported, will bring down malaria cases significantly. 

Patronage of Health Facilities

 The field survey indicated that majority of the households in the Nkoranza South , 51% patronizes hospital at their source of health provider.  (See Table 1.51).  The implication is that the people have realized the need for orthodox treatment with a negligible number still relying on herbal medicine.  One contributing factor to the choice of orthodox medicine has been the introduction of the National Health Insurance Scheme which seeks to eliminate the cash and carry system of health care, thereby making health care accessible to all.  The level of services, personnel and facilities at the hospital and serving as receptive for referral cases have also contributed to the magnitude of patronage.

Moreover, people are gradually appreciating the dangers in self medication, hence only 0.3% are into this practice and or spiritual healing. There is the need for more education programs on the dangers of self medication to eliminate it completely. Health Centre’s, which also have relatively self sufficient facilities for their level of service also, have most of the people patronizing.

Incidence of Maternal, Child and Infant Health

There are problems affecting maternal, infant and child health in the district.  There were five (5) maternal deaths (institutional) in 2009 as against four (4) in 2008 and about 18,594 children had malaria.  This represented approximately 53.6% of the children (0-14) in the Nkoranza South District.  The district recorded 184 deaths at the hospital which represents 0.2% of the population. Total under 5 deaths was 40 in 2009.  About 1.8 of children under age 5 were malnourished in the district. These figures show that the health problems in the district are not as devastating as those of the national and global figures.  It can be attributed to the quality of health service and its affordability.  The district should however double its efforts at controlling malaria.  

There is pressure on the health personnel in the district giving a Doctor-Patient ratio of 1:32,123.  For instance, medical doctors required in the  are 12 and only 3 doctors are available creating a backlog of 9 doctors.  The situation is the same for other health personnel. With increasing numbers of patients who will be seeking health care as a result of the operations of the National Health Insurance Scheme, there is urgent need of posting and attracting more health personnel . 

Citizen’s Assessment of Health Care in the District

In order to assess the quality of health delivery,households were interviewed on their perception on the waiting time for doctor consultation, quality of examination and treatment, availability of  medicines, cost of treatment, condition of facilities, etc. 

The results shows that under the staff constraints, available health workers are doing their best in improving the health of the people as most of the households 68.1% are satisfied with the criteria listed above.  About 31.9% of households are not satisfied with the health delivery process in the district.  Majority of them complained bitterly of the waiting time at the hospital before consultation with a doctor and at the dispensary. The complaints were skewed to the service of St. Theresah’s Hospital, where a lot of people indicated patients have to queue from morning to evening before going home.  It is expected that additional hands (health personnel) will help curb this service delivery challenge. 

Status of National Immunization Programme

Education campaigns on national immunization have gone on well in the district.  As a result, was able to achieve 99.6% coverage on target in 2009 as presented in the table below;

Immunization proprammes now run house-to-house rather than at the health facilities.  This has increased awareness and patronage.

Population Management and Reproductive Health

According to the 2009 Annual Report of the Nkoranza South Municipal Health Directorate, there is effort in place to manage population.  Among these is the access to and use utilization of family planning services such as the use of contraceptives. From the data, 35.9% of Acceptors of family planning methods use condoms.  

Family Planning Services are offered at all health facilities  except the Municipal Hospital, St. Theresah’s which is a Catholic Mission Hospital.  The Catholic institution is not permitted to promote family planning methods. Only sterilization is done at the hospital on live saving grounds.Condom use leads the figures possibly due to its affordability and achievement of dual purpose of preventing pregnancies and sexually Transmitted Diseases including HIV/AIDS.

The object of managing population growth is that there will not be much pressure on social services such as education, and health.  Family planning reach the people through the  Health Personnel, the media and friends.  The basic issue is coverage. It is therefore recommended that outreach education programmes and media coverage be intensified to cover everyone in the Municipality.

Population Manage Campaigns have been education the youth on sexual relationship, fertility regulation, adolescent health, marriage and child bearing; promoting the integration of HIV/AIDS into sexual and reproductive health programmes, delayed marriage and child bearing; promoting government’s policy of compulsory education for children especially the girl-child up to secondary level; and government’s compulsory and universal birth registration.  These are promoted by the Directorate of Health, NGOs and other FBOs.

Health Insurance

Nkoranza South  Health Insurance is referred to the ‘Mecca’ of Health Insurance in Ghana.  The concept of health insurance started as a community Health Financing Scheme in 1992.  With introduction of Government’s User Fee System otherwise known as “Cash and Carry” into Ghana’s health sector in the late 1985, many people had it difficult paying for their health medical bills (especially admissions).Some people did not go to hospital until it was too late or their illness had advanced to a more complicated phase. A lot of people who dared attending hospital absconded without paying for their medical bills after treatment.  This led to fast depletion of the district hospital’s weak finances.  There was therefore the need to address these social and financial problems hence the introduction of the then Nkoranza Community Financing Scheme.

With the promulgation of National Health Insurance Law (ACT 650), there was the need for the Nkoranza Health Insurance Scheme to adhere to the tenets of ACT 650.  The scheme therefore snitched on to the National Health Insurance Scheme (NHIS) in 2003.  The National Health Insurance Act, 2003 (ACT 650) was promulgated with the view to improving access to quality basic health care to Ghanaians, especially the poor, and the vulnerable.

Health Insurance Enrollment

The scheme has currently registered 64,533 members representing 67% of the  population. About 33% of the populations do not patronize the scheme.  This implies that about a third of the population still operate “Cash and Carry System” the HNIS came to abolish.  One of the reasons for non-patronage is because; a lot of the people live distant from nearby health facilities.  These clusters of population obviously see no justification to register for a service they cannot easily access when the need arises.  Inspite of the numerous enrolment drives, such category of people are not motivated to register. The distribution of those registered cuts across the formal and informal sectors and the exempted categories.

Women (57%) patronize the scheme more than men (43%).  This is because women see the scheme as a social security to their fragility as far as their health issues are concerned.  The same reason holds for their children who constitute 47.1% of the scheme’s membership.  As far as the figures indicate, members from the informal sector (39.6%) finance the district scheme and about 12% of members are exempted from paying premium.  The implication is that the informal sector should be encouraged to register in their numbers to sustain the scheme financially. 

Challenges of the  Insurance Scheme

The  Health Insurance Scheme faces a lot of challenges including;

• Low patronage of the scheme
• Lack of permanent office accommodation 
• Inadequate medical officers and paramedical staff to serve insured clients at health facilities, e.g. St. Theresah’s Hospital. This increases the waiting time for patients/clients 
• Negative attitude of some medical personnel towards insured clients of the scheme

These challenges should be addressed to improve the performance of the scheme and health delivery in general in the district. 

HIV / AIDS

HIV/AIDS epidemic is not only a major challenge to global health, but also a developmental problem.  Globally, it is considered to be the fourth most common cause of death. It continues to be the single most important constraint to socio-economic development of many countries, especially Africa, including Ghana which has 1.7% median prevalence rate.  This means that about 1.7% of the population is affected by the disease.

According to the 2009 Annual Report of the District Directorate of Health Services, a total of 6,253 clients were screened, out of which 303 tested positive in 2009, a slight drop from 2008 figure of 332 in 2008.  This gives a median prevalent rate of 3.1% for the district which is higher than the national prevalent rate of 1.7%. High figures are recorded because they are meant for both Nkoranza South and North Districts since the hospital serves the health needs of the two districts. Out of the figure recorded for 2009, 48.5% represents clinical cases and 23.1 for voluntary counseling and testing.  

Several interventions in the area of information, education and communication, management, care and support have been made to halt or reduce the spread of the disease.  Notwithstanding the efforts made, the fight against the epidemic has not ended.  Some of the strategies adopted by the district include;

1. Mitigation of socio-cultural, legal and economic impacts of the pandemic
2. Prevention of New Transmission and Behaviour change 
3. Treatment, Care and Support 
4. Coordination of Programme Activities and Management of Decentralized response 
5. Resource mobilization and Funding of HIV / AIDS Programme
6. Promotion of know-your-status campaign 
7. Research, Surveillance, Monitoring and the disease.
8. Care of the people infected and affected by the disease

The measures are being implemented to reduce new infections and mitigate stigmatization and social effects of the disease.